FDA should get tough on e-cigarettes

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The Food and Drug Administration’s weak rules on electronic cigarettes came under a new round of criticism last week when 29 state attorneys general wrote the agency to say its current proposal to regulate them “fails to address matters of particular concern.”

The 29 officials, including Massachusetts’ Martha Coakley, are right on target. In April, the FDA had said it wanted to ban sales of e-cigarettes to minors. Yet it proposed to give manufacturers complete freedom to market a product that could addict a new generation of users to nicotine, expose users to many potentially dangerous chemicals, and still be a gateway back to tobacco.

The FDA would still allow manufacturers to sell electronic cigarettes with the very candy, cake, spice, and fruit flavors that were banned in 2009 for tobacco because they were luring youth into smoking. In another head scratcher, the FDA would also allow e-cigarette companies to advertise in media banned for tobacco, such as television and magazines. According to a study published last month in the journal Pediatrics, youth exposure to e-cigarette television advertising increased 256 percent from 2011 to 2013.

That figure was cited by the attorneys general in their letter, in which they urged the FDA to ban candy flavors, place the same marketing restrictions on e-cigs as for cigarettes, and strengthen health warnings. Noting studies that link adolescent nicotine use to adult memory loss, impulse control, and depression, the attorneys general suggest labeling that makes it crystal clear that nicotine “is a harmful and addictive chemical.”

The harm has become obvious as child poisonings from playing with or accidentally swallowing liquid e-cigarette flavorings have skyrocketed. They have reached such a level that a Centers for Disease Control and Prevention report in April said, “developing strategies to monitor and prevent future poisonings is critical.”

The saga of e-cigarette regulation took a particularly mysterious turn this summer when Reuters reported that a key reason for the tameness of the FDA’s rules was because the Obama administration’s Office of Management and Budget significantly weakened the FDA drafts. OMB deleted language voicing concern for the safety of e-cigarettes, a proposal to review cartridges for harmful levels of toxic chemicals, and language that could have led to a ban on online sales. In a parallel revision, OMB also weakened proposed new rules for cigars and deleted FDA estimates of how many lives and how much money would be saved with reductions in cigar smoking.

That lobbying clearly has muted the cry for tough, proactive regulation. To be sure, e-cigarettes do not contain the carcinogens of burnt tobacco. E-cigarettes, with proper medical supervision, may help people stop smoking. But the fact that companies are using celebrities to market them as a way of being cool strongly suggests that the overriding goal of the industry is to get millions of people around the world hooked.

In the five years since, the barrage of advertising and the exploding use of e-cigarettes among young people make it imperative for Obama and the FDA to listen to the pleas of the top medical societies, public health associations, and, now, the majority of state attorneys general. Without strong action by the administration, e-cigarettes will become a temptation young people cannot resist.